Evie Summers
Sleep is an essential part of our lives, but it can be frustrating when we can't sleep or wake up early. Sleep-maintenance insomnia, or the inability to stay asleep, is a common problem, with many people waking up in the early hours of the morning and struggling to get back to sleep. This can be caused by various factors, including genetics, age, and underlying health conditions. For example, women are more likely than men to experience sleep-maintenance insomnia due to hormonal changes and psychological stress. Luckily, there are several treatment options and lifestyle changes that can help, such as cognitive-behavioral therapy, sleep restriction, and improving sleep hygiene.
| Characteristics | Values |
|---|---|
| Sleep time | 2-3 hours before the alarm |
| Sleep pattern | Morning larks, night owls, and hummingbirds |
| Sleep-related disorders | Insomnia, sleep apnea, depression |
| Sleep deprivation causes | Hormonal changes, heartburn, nausea, vomiting, leg cramping, shortness of breath, discomfort in the abdomen, breast tenderness, vivid dreams, back pain, sinus congestion, hip pain, etc. |
| Sleep deprivation solutions | Meditation, deep breathing, progressive muscle relaxation, biofeedback, cognitive behavioral therapy, melatonin, etc. |
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What You'll Learn
Sleep-maintenance insomnia
While there is no single cause of sleep-maintenance insomnia, certain factors can increase the risk of developing it. Age is one such factor, as the amount of time spent in deep sleep decreases with advancing age, affecting the circadian rhythm and sleep-wake cycle. Additionally, women are more prone to insomnia due to hormonal changes, especially during menopause, which can make it challenging to stay asleep.
To address sleep-maintenance insomnia, it is recommended to seek professional help and make necessary lifestyle adjustments. Sleep therapy, specifically Cognitive Behavioural Therapy for Insomnia (CBT-i), has been proven effective in improving sleep patterns. CBT-i is a specialised form of psychotherapy that addresses thoughts, habits, and behaviours that impact sleep. It combines sleep education and therapy techniques to identify and modify factors contributing to poor sleep.
Additionally, maintaining good sleep habits and practising relaxation techniques can promote better sleep. This includes creating a sleep-friendly environment by ensuring the bedroom is cool, dark, and comfortable. Relaxation techniques such as meditation, deep breathing, progressive muscle relaxation, and biofeedback can help calm the mind and relax the body, making it easier to fall back asleep.
It is also suggested to go to bed later than usual, as this can help build up sleep drive, making it easier to sleep through the night. However, it is important to avoid spending too much time in bed, as it can lead to increased worry about not sleeping, further exacerbating insomnia.
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Sleep-onset insomnia
Several factors can contribute to sleep-onset insomnia, including older age, stress, anxiety, and certain lifestyle choices. Stress and anxiety about work, school, finances, or relationships can increase the risk of developing insomnia or worsen existing sleep issues. Additionally, worrying about the amount of sleep one is getting or constantly checking the clock while trying to sleep can also contribute to sleep-onset insomnia. Lifestyle factors, such as deviating from a regular sleep schedule, caffeine consumption, alcohol, nicotine, or recreational drug use, can also play a role.
Genetics may also influence sleep patterns, with some individuals being naturally early risers (Morning Larks) or night owls (Night Owls), while others fall somewhere in between (Hummingbirds). Sleep-onset insomnia may be more common in women, especially during midlife transitions and hormonal changes.
To address sleep-onset insomnia, individuals can consider various techniques and treatments. Cognitive-behavioural therapy (CBT-I) is often recommended, which involves identifying and changing unhelpful thoughts and behaviours that impact sleep. This may include keeping a sleep diary to track sleep patterns and improve sleep efficiency. Sleep restriction, or going to bed later, can also be effective in building up sleep drive and improving sleep quality. It is important to avoid spending too much time in bed awake, as it can lead to a vicious cycle of worry and insomnia. Relaxation techniques such as meditation, deep breathing, progressive muscle relaxation, or biofeedback can help calm the mind and body, making it easier to fall asleep.
If sleep-onset insomnia is affecting your daily life, it is essential to consult a healthcare professional. They can help identify the underlying causes and recommend appropriate treatments or medications to improve sleep quality and duration.
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Pregnancy-related insomnia
To cope with pregnancy-related insomnia, maintaining a regular sleep schedule is essential. This includes going to bed and waking up at similar times each day. While naps can help make up for lost sleep, they should be avoided in the afternoon and evening. Creating a comfortable sleep environment is also beneficial—keep the room cool, dark, and quiet, removing electronic devices, and using a nightlight for bathroom trips. Additionally, using pillows for support can help reduce back pain and improve sleep quality.
Pregnant women can also try various relaxation techniques, such as those learned in childbirth classes, to aid sleep. If sleep difficulties persist, seeking advice from a healthcare provider is recommended. They may suggest cognitive and behavioral techniques or, if necessary, prescribe medication.
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Sleep restriction
The idea behind SRT is that the more time a person spends lying in bed unable to sleep, the more they feel negative, stressed, and pressured. This makes falling and staying asleep much harder to achieve. By limiting the time they spend awake in bed, a person can shorten the time it takes for them to fall asleep and improve their overall quality of sleep.
To start SRT, a person will work with a sleep therapist who will ask them to keep a sleep diary for 1–2 weeks. In the diary, they should record how long they spend in bed and estimate the length of time they sleep each day. The sleep specialist will then determine the maximum time that a person can spend in bed based on their average total sleep time, or sleep window, per week. For example, a person who goes to bed at 10 pm and wakes up at 8 am but only sleeps on average for 6 hours per night should restrict their sleep window to 6 hours. They could, therefore, go to bed at 11:30 pm and get up at 5:30 am. However, practitioners advise that people do not restrict their time in bed to less than 5 hours regardless of their average sleep time.
There is no fixed time frame for SRT to work, but it generally takes about 2–8 weeks of consistency and commitment to sticking to the technique and a fixed sleep schedule. SRT is usually the first line of treatment for insomnia and is often part of CBT-I (cognitive behavioural therapy for insomnia), but it may be available as a stand-alone therapy.
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Sleep efficiency
A normal sleep efficiency score is considered to be 85% or higher. If you're spending less than 80% of your time in bed asleep, you're probably spending too much time in bed. This can lead to a vicious cycle where the worry of not getting enough sleep becomes a source of insomnia.
To improve your sleep efficiency, you can try the following:
- Keep a sleep diary for one to two weeks to track your sleep patterns, especially how much time you spend in bed and how much of that time you're awake.
- Based on your diary, calculate how much sleep you get each night on average. If you get six hours of sleep and need to wake up at 6 a.m., then don't go to bed until midnight, even if you feel sleepy before then.
- Avoid napping during the day.
- Once you've been able to sleep for most of your allotted sleep time for five to seven days, go to bed 15 minutes earlier. Repeat this process until you reach an optimal sleep efficiency of 85% or more.
- If you find that you're falling asleep too early in the evening, keep the lights bright where you're sitting or working. This can slow the release of the hormone melatonin, which rises when it's dark and promotes sleep.
- Meditation, deep breathing, progressive muscle relaxation, or biofeedback can help calm your mind and relax your muscles.
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Frequently asked questions
There are many reasons why you might wake up early and be unable to fall back asleep. This could be due to genetics, age, stress, depression, or insomnia.
Insomnia is a sleeping disorder characterised by the inability to fall asleep, stay asleep, or both. If you're experiencing insomnia more than three times a week for longer than three months, you could be diagnosed with chronic insomnia.
There are several treatment options and lifestyle changes that can help you get a full night's sleep again. Maintaining good sleep habits, practising relaxation techniques, and cognitive and behavioural techniques have proven effective.
To stop waking up early, try going to bed later. This will help build up your sleep drive so that you find it easier to sleep through the night. Also, avoid watching the clock and worrying about how little sleep you've gotten.
To wake up early feeling refreshed, set a dependable sleep schedule by going to sleep and waking up at the same time every day. Get exposure to bright light in the morning, as this helps regulate your circadian rhythm and makes your body feel more alert throughout the day.
